DEATH BY MEDICINE Part 4

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DEATH BY MEDICINE Part 4

 

 

PUBLIC SUGGESTIONS ON IATROGENESIS

 

In a telephone survey, 1,207 adults were asked to

indicate how effective they thought the following

would be in reducing preventable medical errors that

resulted in serious harm:36

 

& #61623; giving doctors more time to spend with

patients: very effective 78%

 

& #61623; requiring hospitals to develop systems to

avoid medical errors: very effective 74%

 

& #61623; better training of health professionals: very

effective 73%

 

& #61623; using only doctors specially trained in

intensive care medicine on intensive care units: very

effective 73%

 

& #61623; requiring hospitals to report all serious

medical errors to a state agency: very effective 71%

 

& #61623; increasing the number of hospital nurses:

very effective 69%

 

& #61623; reducing the work hours of

doctors-in-training to avoid fatigue: very effective

66%

 

& #61623; encouraging hospitals to voluntarily report

serious medical errors to a state agency: very

effective 62%

 

DRUG IATROGENESIS

 

Drugs comprise the major treatment modality of

scientific medicine. With the discovery of the " Germ

Theory " medical scientists convinced the public that

infectious organisms were the cause of illness.

Finding the " cure " for these infections proved much

harder than anyone imagined. From the beginning,

chemical drugs promised much more than they delivered.

But far beyond not working, the drugs also caused

incalculable side effects. The drugs themselves, even

when properly prescribed, have side effects that can

be fatal, as Lazarou’s study1 shows. But human error

can make the situation even worse.

 

Medication Errors

 

A survey of a 1992 national pharmacy database found a

total of 429,827 medication errors from 1,081

hospitals. Medication errors occurred in 5.22% of

patients admitted to these hospitals each year. The

authors concluded that a minimum of 90,895 patients

annually were harmed by medication errors in the

country as a whole.37

 

A 2002 study shows that 20% of hospital medications

for patients had dosage mistakes. Nearly 40% of these

errors were considered potentially harmful to the

patient. In a typical 300-patient hospital the number

of errors per day were 40.38

 

Problems involving patients’ medications were even

higher the following year. The error rate intercepted

by pharmacists in this study was 24%, making the

potential minimum number of patients harmed by

prescription drugs 417,908.39

 

Recent Adverse Drug Reactions

 

More recent studies on adverse drug reactions show

that the figures from 1994 (published in Lazarou’s

1998 JAMA article) may be increasing. A 2003 study

followed four hundred patients after discharge from a

tertiary care hospital (hospital care that requires

highly specialized skills, technology, or support

services). Seventy-six patients (19%) had adverse

events. Adverse drug events were the most common at

66%. The next most common events were

procedure-related injuries at 17%.40

 

In a NEJM study an alarming one-in-four patients

suffered observable side effects from the more than

3.34 billion prescription drugs filled in 2002.41 One

of the doctors who produced the study was interviewed

by Reuters and commented that, " With these 10-minute

appointments, it's hard for the doctor to get into

whether the symptoms are bothering the patients. " 42

William Tierney, who editorialized on the NEJM study,

said " … given the increasing number of powerful drugs

available to care for the aging population, the

problem will only get worse. " The drugs with the worst

record of side effects were the SSRIs, the NSAIDs, and

calcium-channel blockers. Reuters also reported that

prior research has suggested that nearly 5% of

hospital admissions - over 1 million per year - are

the result of drug side effects. But most of the cases

are not documented as such. The study found one of the

reasons for this failure: in nearly two-thirds of the

cases, doctors couldn’t diagnose drug side effects or

the side effects persisted because the doctor failed

to heed the warning signs.

 

Medicating Our Feelings

 

We only need to look at the side effects of

antidepressant drugs, which give hope to a depressed

population. Patients seeking a more joyful existence

and relief from worry, stress, and anxiety, fall

victim to the messages blatantly displayed on TV and

billboards. Often, instead of relief, they also fall

victim to a myriad of iatrogenic side effects of

antidepressant medication.

 

Also, a whole generation of antidepressant users has

resulted from young people growing up on Ritalin.

Medicating youth and modifying their emotions must

have some impact on how they learn to deal with their

feelings. They learn to equate coping with drugs and

not their inner resources. As adults, these medicated

youth reach for alcohol, drugs, or even street drugs,

to cope. According to the Journal of the American

Medical Association, " Ritalin acts much like

cocaine. " 43 Today’s marketing of mood-modifying drugs,

such as Prozac or Zoloft, makes them not only socially

acceptable but almost a necessity in today’s stressful

world.

 

Television Diagnosis

 

In order to reach the widest audience possible, drug

companies are no longer just targeting medical doctors

with their message about antidepressants. By 1995 drug

companies had tripled the amount of money allotted to

direct advertising of prescription drugs to consumers.

The majority of the money is spent on seductive

television ads. From 1996 to 2000, spending rose from

$791 million to nearly $2.5 billion.44 Even though

$2.5 billion may seem like a lot of money, the authors

comment that it only represents 15% of the total

pharmaceutical advertising budget. According to

medical experts " there is no solid evidence on the

appropriateness of prescribing that results from

consumers requesting an advertised drug. " However, the

drug companies maintain that direct-to-consumer

advertising is educational. Dr. Sidney M. Wolfe, of

the Public Citizen Health Research Group in

Washington, D.C., argues that the public is often

misinformed about these ads.45 People want what they

see on television and are told to go to their doctor

for a prescription. Doctors in private practice either

acquiesce to their patients’ demands for these drugs

or spend valuable clinic time trying to talk patients

out of unnecessary drugs. Dr. Wolfe remarks that one

important study found that people mistakenly believe

that the " FDA reviews all ads before they are released

and allows only the safest and most effective drugs to

be promoted directly to the public. " 46

 

How Do We Know Drugs Are Safe?

 

Another aspect of scientific medicine that the public

takes for granted is the testing of new drugs. Unlike

the class of people that take drugs who are ill and

need medication, in general, drugs are tested on

individuals who are fairly healthy and not on other

medications that can interfere with findings. But when

they are declared " safe " and enter the drug

prescription books, they are naturally going to be

used by people on a variety of other medications and

who also have a lot of other health problems. Then, a

new Phase of drug testing called Post-Approval comes

into play, which is the documentation of side effects

once drugs hit the market. In one very telling report,

the General Accounting Office (an agency of the U.S.

Government) " found that of the 198 drugs approved by

the FDA between 1976 and 1985... 102 (or 51.5%) had

serious post-approval risks... the serious

post-approval risks (included) heart failure,

myocardial infarction, anaphylaxis, respiratory

depression and arrest, seizures, kidney and liver

failure, severe blood disorders, birth defects and

fetal toxicity, and blindness. " 47

 

The investigative show NBC’s " Dateline " wondered if

your doctor is moonlighting as a drug rep. After a

year-long investigation they reported that because

doctors can legally prescribe any drug to any patient

for any condition, drug companies heavily promote

" off-label " and frequently inappropriate and

non-tested uses of these medications in spite of the

fact that these drugs are only approved for specific

indications they have been tested for.48

 

The leading causes of adverse drug reactions are

antibiotics (17%), cardiovascular drugs (17%),

chemotherapy (15%), and analgesics and

anti-inflammatory agents (15%).49

 

Specific Drug Iatrogenesis: Antibiotics

 

Dr. Egger, in a recent editorial, wrote that after

fifty years of increasing use of antibiotics, 30

million pounds of antibiotics are used in America per

year.50 Twenty-five million pounds of this total are

used in animal husbandry. The vast majority of this

amount, twenty-three million pounds, is used to try to

prevent disease, the stress of shipping, and to

promote growth. Only 2 million pounds are given for

specific animal infections. Dr. Egger reminds us that

low concentrations of antibiotics are measurable in

many of our foods, rivers, and streams around the

world. Much of this is seeping into bodies of water

from animal farms.

 

Egger says overuse of antibiotics results in

food-borne infections resistant to antibiotics.

Salmonella is found in 20% of ground meat but constant

exposure of cattle to antibiotics has made 84% of

salmonella resistant to at least one anti-salmonella

antibiotic. Diseased animal food accounts for 80% of

salmonellosis in humans, or 1.4 million cases per

year. The conventional approach to dealing with this

epidemic is to radiate food to try to kill all

organisms but keep using the antibiotics that cause

the original problem. Approximately 20% of chickens

are contaminated with Campylobacter jejuni causing 2.4

million human cases of illness annually. Fifty-four

percent of these organisms are resistant to at least

one anti-campylobacter antimicrobial.

 

A ban on growth-promoting antibiotics in Denmark began

in 1999, which led to a decrease from 453,200 pounds

to 195,800 pounds within a year. Another report from

Scandinavia found that taking away antibiotic growth

promoters had no or minimal effect on food production

costs. Egger further warns that in America the current

crowded, unsanitary methods of animal farming support

constant stress and infection, and are geared toward

high antibiotic use. He says these conditions would

have to be changed along with cutting back on

antibiotic use.

 

In America, over 3 million pounds of antibiotics are

used every year on humans. With a population of 284

million Americans, this amount is enough to give every

man, woman and child 10 teaspoons of pure antibiotics

per year. Egger says that exposure to a steady stream

of antibiotics has altered pathogens such as

Streptococcus pneumoniae, Staplococcus aureus, and

entercocci, to name a few.

 

Almost half of patients with upper respiratory tract

infections in the U.S. still receive antibiotics from

their doctor.51 According to the CDC, 90% of upper

respiratory infections are viral and should not be

treated with antibiotics. In Germany the prevalence

for systemic antibiotic use in children aged 0-6 years

was 42.9%.52

 

Data taken from nine U.S. health plans between

1996-2000 on antibiotic use in 25,000 children found

that rates of antibiotic use decreased. Antibiotic use

in children, aged 3 months to under 3 years, decreased

24%, from 2.46 to 1.89 antibiotic prescriptions

per/patient per/year. For children, 3 years to under 6

years, there was a 25% reduction from 1.47 to 1.09

antibiotic prescriptions per/patient per/year. And for

children aged 6 to under 18 years, there was a 16%

reduction from 0.85 to 0.69 antibiotic prescriptions

per/ patient /per year.53 Although there was a

reduction in antibiotic use, the data indicate that on

average every child in America receives 1.22

antibiotic prescriptions annually.

 

Group A beta-hemolytic streptococci is the only common

cause of sore throat that requires antibiotics,

penicillin and erythromycin being the only recommended

treatment. However, 90% of sore throats are viral. The

authors of this study estimated there were 6.7 million

adult annual visits for sore throat between 1989 and

1999 in the U.S. Antibiotics were used in 73% of

visits. Furthermore, patients treated with antibiotics

were given non-recommended broad-spectrum antibiotics

in 68% of visits. The authors noted, that from 1989 to

1999, there was a significant increase in the newer

and more expensive broad-spectrum antibiotics and a

decrease in use of penicillin and erythromycin, which

are the recommended antibiotics.54 If antibiotics were

given in 73% of visits and should have only been given

in 10%, this represents 63%, or a total of 4.2 million

visits for sore throat that ended in unnecessary

antibiotic prescriptions between1989-1999. Dr. Richard

Besser, of the CDC, in 1995, said the number of

unnecessary antibiotics prescribed annually for viral

infections was 20 million. Dr. Besser, in 2003, now

refers to tens of millions of unnecessary

antibiotics.2,2a Neither of these figures takes into

account the number of unnecessary antibiotics used for

non-fatal conditions such as acne, intestinal

infection, skin infections, ear infections, etc.

 

The Problem with Antibiotics: They are Anti-Life

 

On September 17, 2003 the CDC relaunched a program,

started in 1995, called " Get Smart: Know When

Antibiotics Work. " 55 This is a $1.6 million campaign

to educate patients about the overuse and

inappropriate use of antibiotics. Most people involved

with alternative medicine have known about the dangers

of overuse of antibiotics for decades. Finally the

government is focusing on the problem, yet they are

only putting a miniscule amount of money into an

iatrogenic epidemic that is costing billions of

dollars and thousands of lives. The CDC warns that 90%

of upper respiratory infections, including children’s

ear infections, are viral, and antibiotics don’t treat

viral infection. More than 40% of about 50 million

prescriptions for antibiotics each year in physicians'

offices were inappropriate.2 And using antibiotics,

when not needed, can lead to the development of deadly

strains of bacteria that are resistant to drugs and

cause more than 88,000 deaths due to hospital-acquired

infections.9 However, the CDC seems to be blaming

patients for misusing antibiotics even though they are

only available on prescription from a doctor who

should know how to prescribe properly. Dr. Richard

Besser, head of " Get Smart, " says " Programs that have

just targeted physicians have not worked.

Direct-to-consumer advertising of drugs is to blame in

some cases. " Dr. Besser says the program " teaches

patients and the general public that antibiotics are

precious resources that must be used correctly if we

want to have them around when we need them. Hopefully,

as a result of this campaign, patients will feel more

comfortable asking their doctors for the best care for

their illnesses, rather than asking for

antibiotics. " 56

 

And what does the " best care " constitute? The CDC does

not elaborate and patently avoids the latest research

on the dozens of nutraceuticals scientifically proven

to treat viral infections and boost the immune system.

Will their doctors recommend vitamin C, echinacea,

elderberry, vitamin A, zinc, or homeopathic

oscillococcinum? No, they won’t. The archaic solutions

offered by the CDC include a radio ad, " Just Say No -

Snort, sniffle, sneeze - No antibiotics please. " Their

commonsense recommendations, that most people do

anyway, include resting, drinking plenty of fluids,

and using a humidifier.

 

The pharmaceutical industry claims they are all for

limiting the use of antibiotics. In order to make sure

that happens, the drug company Bayer is sponsoring a

program called, " Operation Clean Hands " , through an

organization called LIBRA.57 The CDC is also involved

with trying to minimize antibiotic resistance, but

nowhere in their publications is there any reference

to the role of nutraceuticals in boosting the immune

system nor to the thousands of journal articles that

support this approach. This recalcitrant tunnel vision

and refusal to use available non-drug alternatives is

absolutely inappropriate when the CDC is desperately

trying to curb the nightmare of overuse of

antibiotics. The CDC should also be called to task

because it is only focusing on the overuse of

antibiotics. There are similar nightmares for every

class of drug being prescribed today.

 

Drugs Pollute Our Water Supply

 

We have reached the point of saturation with

prescription drugs. We have arrived at the point where

every body of water tested contains measurable drug

residues. We are inundated with drugs. The tons of

antibiotics used in animal farming, which run off into

the water table and surrounding bodies of water, are

conferring antibiotic resistance to germs in sewage,

and these germs are also found in our water supply.

Flushed down our toilets are tons of drugs and drug

metabolites that also find their way into our water

supply. We have no idea what the long-term

consequences of ingesting a mixture of drugs and

drug-breakdown products will do to our health. It’s

another level of iatrogenic disease that we are unable

to completely measure.58-67

 

Specific Drug Iatrogenesis: NSAIDs

 

It’s not just America that is plagued with

iatrogenesis. A survey of 1072 French general

practitioners (GPs) tested their basic pharmacological

knowledge and practice in prescribing NSAIDs.

Non-steroidal anti-inflammatory drugs (NSAIDs) rank

first among commonly prescribed drugs for serious

adverse reactions. The results of the study suggested

that GPs don’t have adequate knowledge of these drugs

and are unable to effectively manage adverse

reactions.68

 

A cross-sectional survey of 125 patients attending

specialty pain clinics in South London found that

possible iatrogenic factors such as

" over-investigation, inappropriate information, and

advice given to patients as well as misdiagnosis,

over-treatment, and inappropriate prescription of

medication were common. " 69

 

Specific Drug Iatrogenesis: Cancer Chemotherapy

 

In 1989, a German biostatistician, Ulrich Abel PhD,

after publishing dozens of papers on cancer

chemotherapy, wrote a monograph " Chemotherapy of

Advanced Epithelial Cancer " . It was later published in

a shorter form in a peer-reviewed medical journal.70

Dr. Abel presented a comprehensive analysis of

clinical trials and publications representing over

3,000 articles examining the value of cytotoxic

chemotherapy on advanced epithelial cancer. Epithelial

cancer is the type of cancer we are most familiar

with. It arises from epithelium found in the lining of

body organs such as breast, prostate, lung, stomach,

or bowel. From these sites cancer usually infiltrates

into adjacent tissue and spreads to bone, liver, lung,

or the brain. With his exhaustive review Dr. Abel

concludes that there is no direct evidence that

chemotherapy prolongs survival in patients with

advanced carcinoma. He said that in small-cell lung

cancer and perhaps ovarian cancer the therapeutic

benefit is only slight. Dr. Abel goes on to say, " Many

oncologists take it for granted that response to

therapy prolongs survival, an opinion which is based

on a fallacy and which is not supported by clinical

studies. "

 

Over a decade after Dr. Abel’s exhaustive review of

chemotherapy, there seems no decrease in its use for

advanced carcinoma. For example, when conventional

chemotherapy and radiation has not worked to prevent

metastases in breast cancer, high-dose chemotherapy

(HDC) along with stem-cell transplant (SCT) is the

treatment of choice. However, in March 2000, results

from the largest multi-center randomized controlled

trial conducted thus far showed that, compared to a

prolonged course of monthly conventional-dose

chemotherapy, HDC and SCT were of no benefit.71 There

was even a slightly lower survival rate for the

HDC/SCT group. And the authors noted that serious

adverse effects occurred more often in the HDC group

than the standard-dose group. There was one

treatment-related death (within 100 days of therapy)

in the HDC group, but none in the conventional

chemotherapy group. The women in this trial were

highly selected as having the best chance to respond.

 

There is also no all-encompassing follow-up study like

Dr. Abel’s that tells us if there is any improvement

in cancer-survival statistics since 1989. In fact, we

need to research whether chemotherapy itself is

responsible for secondary cancers instead of

progression of the original disease. We continue to

question why well-researched alternative cancer

treatments aren’t used.

 

Drug Companies Fined

 

Periodically, a drug manufacturer is fined by the FDA

when the abuses are too glaring and impossible to

cover up. The May 2002 Washington Post reported that

the maker of Claritin, Schering-Plough Corp., was to

pay a $500 million dollar fine to the FDA for

quality-control problems at four of its factories.72

The FDA tabulated infractions that included 90%, or

125 of the drugs they made since 1998. Besides the

fine, the company had to stop manufacturing 73 drugs

or suffer another $175 million dollar fine. PR

statements by the company told another story. The

company assured consumers that they should still feel

confident in its products.

 

Such a large settlement serves as a warning to the

drug industry about maintaining strict manufacturing

practices and has given the FDA more clout in dealing

with drug company compliance. According to the

Washington Post article, a federal appeals court ruled

in 1999 that the FDA could seize the profits of

companies that violate " good manufacturing practices. "

Since that time Abbott Laboratories Inc. paid $100

million for failing to meet quality standards in the

production of medical test kits, and Wyeth

Laboratories Inc. paid $30 million in 2000 to settle

accusations of poor manufacturing practices.

 

The indictment against Schering-Plough came after the

Public Citizen Health Research Group, lead by Dr.

Sidney Wolfe, called for a criminal investigation of

Schering-Plough, charging that the company distributed

albuterol asthma inhalers even though it knew the

units were missing the active ingredient.